“Metronomic” chemotherapy in advanced soft tissue sarcomas

Italiano, Antoîne; Toulmonde, Maud; Lortal, Barbara; Stoeckle, Eberhard; Garbay, Delphine; Kantor, G.; Kind, Michèle; Coindre, Jean‐Michel; Bui, Binh

doi:10.1007/s00280-010-1275-3

Cited by 23 publications

(16 citation statements)

References 26 publications

(26 reference statements)

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“…Routine with metronomic chemotherapy. Continuous low doses of some chemotherapeutic agents target the endothelial cells of tumour vasculature, inducing hypoxia and nutrient deprivation (Pasquier 2010) and inhibiting tumour growth (Italiano et al 2010). In humans a number of chemotherapeutic agents have been used at continuous low dose administration, these include etoposide, cyclophosphamide, methotrexate, paclitaxel, vinblastine, doxorubicin, 5-fluorouracil (Bocci et al 2002) and chlorambucil (Leach et al 2012).…”

Section: Case Presentationmentioning

confidence: 99%

A novel approach to treatment of lymphangiosarcoma in a boxer dog

Marcinowska

Warland

Brearley

et al. 2013

J of Small Animal Practice

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A five-year-old female boxer presented with a swelling in the area of the caudal mammary gland. The mass was surgically excised and histopathological examination revealed a poorly demarcated lesion, extending into mammary tissue and infiltrating the sinuses of adjacent lymph nodes. The diagnosis was lymphangiosarcoma. Full blood work, thoracic radiographs, abdominal and scar ultrasound were unremarkable, apart from possible inflammatory reactions in the latter and reactive/metastatic changes in inguinal lymph nodes. Doxorubicin treatment resulted in a 6-month recurrence free interval. At relapse, the dog was treated with metronomic chemotherapy using chlorambucil and meloxicam, which failed to adequately control the disease. Toceranib phosphate was introduced and resulted in almost complete regression of the mass, leaving just a skin plaque. To the authors' knowledge this is the first report describing the use of two novel therapeutic approaches to treat canine lymphangiosarcoma that resulted in a higher than previously described survival time.

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Section: Case Presentationmentioning

confidence: 99%

A novel approach to treatment of lymphangiosarcoma in a boxer dog

Marcinowska

Warland

Brearley

et al. 2013

J of Small Animal Practice

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“…Many patients are in mild performance status, in our group of patients 25% were PS 2. In most patients with metastatic STS two or more morbidities are concomitant, and administration of chemotherapy decreases with age (4,23). Only 11% of our patients older than 75 years received a chemotherapy regimen.…”

Section: Discussionmentioning

confidence: 86%

Metastatic soft tissue sarcomas (STS) in elderly patients: 18 years of monoinstitutional experience.

Comandone

Boglione

Giubellino

et al. 2017

JCO

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e22528 Background: Elderly people represent more than 50% of STS patients, but few data are available in this population and old patients in clinical studies are underrepresented or not included. Aim of this retrospective, monoinstitutional study is to describe the activity and feasibility of first and second line chemotherapy in elderly patients with metastatic STS. Methods: Patients older than 65, with metastatic STS of the scalp, trunk, girdles and extremities, treated and followed from February 1998 to December 2015 in an Italian referral Center for diagnosis and care of STS were included. Median Overall survival (OS) was the principal end point calculated from the start of chemotherapy to the last date of follow up or death. Response rate and toxicities related to type of administered chemotherapy were the secondary end points. Results: 134 patients (79 M, 55F) were considered, (65-70 y) 63%, (71- 75y) 25%, ( > 76 y)11% . STS histologies: mixoid and round cell liposarcomas (34%), leiomyosarcomas (25%), pleomorphic undifferentiated sarcomas (13%), Angiosarcoma (10%), Mixofibrosarcoma (6%), MPNST (4%), synovial sarcoma (2%), other histologies (6%). All the patients received at least one course chemotherapy (1-12). Mono CT was the preferred administered schedule (92%of cases). Median OS was 7.3 months; at the time of this analysis only 14 patients were alive (10%). In the first line therapy we recorded 1 CR, 14 PR and 43 SD. In second line therapy no CR, 4 PR, 23 SD. PR were recorded mainly in 65-70y old patients. Bad PS, low score in Comprehensive Geriatric Assesment (CGA), vulnerability, comorbidities, number of metastasis, were negative prognostic factors. No toxic death were recorded. 12% of the pts were recovered for febrile neutropenia, thrombocitopenia and mucositis . Conclusions: Our study confirms that elderly patients with metastatic STS is a difficult population to be treated. Only patients less aged, good PS, good GCA and 0-1 comorbidities can be treated with full dose of drug, generally with mono CT. Chemotherapy in elderly pts doesn’t produce a significant improvement in Median Survival and benefit observed support the routine use of citotoxic treatment in selected good performance status population.

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“…7,[25][26][27][28][29][30][31] The low drug doses decrease the risk of toxicity and adverse effects (eg, vomiting, inappetence, and hematologic derangements) commonly associated with chemotherapeutic protocols. 7,27,30,31 In mammals, metronomic chemotherapeutic protocols have both direct and indirect effects on the host immune system and tumor cells that are not yet fully understood.…”

Section: Discussionmentioning

confidence: 99%

“…This treatment modality is believed to down-regulate tumor angiogenesis by targeting vascular endothelial cells vital to the growth and development of tumor cells. 7,[27][28][29][30] Additionally, metronomic chemotherapy is believed to play a role in immune modulation via the up-regulation of the body's natural anticancer response and initiation of tumor quiescence through suppression of regulatory T-cell function. [25][26][27]30 Regulatory T cells, such as the mammalian CD4þ and CD25þ cells, are increased in many neoplastic conditions and are linked to increased tumor progression and spread, as well as to decreased response to a tumor by the host's immune system.…”

Section: Discussionmentioning

confidence: 99%

Metronomic Chemotherapy for Myxosarcoma Treatment in a Kori Bustard (Ardeotis kori)

Sander¹,

Hope²,

McNeill³

et al. 2015

Journal of Avian Medicine and Surgery

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A 22-year-old, wild-caught male kori bustard (Ardeotis kori) developed a large, slow-growing subcutaneous mass over the keel. The mass was surgically debulked and histopathologically described as a myxosarcoma. Surgical dehiscence and concurrent local tumor regrowth, with no evidence of metastasis, occurred over the subsequent 3 months, necessitating 2 additional surgical procedures to close the wound. At 19 weeks after the initial procedure, a second debulking surgical procedure was performed, at which time carboplatin-impregnated matrix beads were placed in the lesion. Moderate local tumor regrowth was clinically appreciable 4 weeks after surgery, at which time an oral metronomic chemotherapeutic protocol consisting of daily cyclophosphamide (10 mg/m(2)) and meloxicam (0.1 mg/kg) was initiated. Four months later, the tumor was no longer palpable. While oral therapy was discontinued during the breeding season, mass regrowth was observed, and the mass was surgically debulked before reinitiating oral chemotherapy. Treatment was extended for over 1 year with no hematologic evaluation or serum biochemical abnormalities, and the bird otherwise remained clinically healthy. To our knowledge, this is the first report of a myxosarcoma in a bustard species and the first report of successful clinical application of metronomic chemotherapy in an avian species.

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“Metronomic” chemotherapy in advanced soft tissue sarcomas

Cited by 23 publications

References 26 publications

A novel approach to treatment of lymphangiosarcoma in a boxer dog

A novel approach to treatment of lymphangiosarcoma in a boxer dog

Metastatic soft tissue sarcomas (STS) in elderly patients: 18 years of monoinstitutional experience.

Metronomic Chemotherapy for Myxosarcoma Treatment in a Kori Bustard (Ardeotis kori)

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